and adolescent needs and strengths...

© Copyright Praed Foundation 1999, 2010 1

3/27/2010

Child/Youth and Adolescent Needs and Strengths (CANS©)

OTTAWA SERVICE COLLABORATIVE

INTEGRATED PLAN OF CARE PROCESS VERSION

AN INFORMATION INTEGRATION TOOL

CANS© MANUAL

October 2014


A large number of individuals have collaborated in the development of the CANS‐MH. Along with the CANS versions for developmental disabilities, juvenile justice, and Child/youth welfare, this information integration tool is designed to support individual case planning and the planning and evaluation of service systems. The CANS‐MH is an open domain tool for use in service delivery systems that address the mental health of children, adolescents and their families. The copyright is held by the Praed Foundation to ensure that it remains free to use. For specific permission to use please contact the Praed Foundation. For more information on the CANS assessment tool contact:

John S. Lyons, Ph.D. University of Ottawa

Children’s Hospital of Eastern Ontario 401 Smyth Road, R1118

Ottawa, ON [email protected]

Lise Bisnaire, Ph.D, Martine Roberge, Ph.D. Children’s Hospital of Eastern Ontario

Ellen Waxman, Ph.D. Roberts Smart Centre 1199 Carling Street

Ottawa, ON [email protected]

Praed Foundation 550 N. Kingsbury Street, Suite 101

Chicago, IL 60654 [email protected] www.praedfoundation.org


INTRODUCTION The CANS is a multiple purpose information integration tool that is designed to be the output of an assessment process. The purpose of the CANS is to accurately represent the shared vision of the child/youth serving system—children, youth, and families. As such, completion of the CANS is accomplished in order to allow for the effective communication of this shared vision for use at all levels of the system. Since its primary purpose is communication, the CANS is designed based on communication theory rather than the psychometric theories that have influenced most measurement development. There are six key principles of a communimetric measure that apply to understanding the CANS. Six Key Principles of the CANS

1. Items were selected because they are each relevant to service/treatment planning. An item exists because it might lead you down a different pathway in terms of planning actions.

2. Each item uses a 4‐level rating system. Those levels are designed to translate immediately into action levels. Different action levels exist for needs and strengths. For a description of these action levels please see below.

3. Rating should describe the child/youth, not the child/youth in services. If an intervention is present that is masking a need but must stay in place, this should be factored into the rating consideration and would result in a rating of an “actionable” need (i.e. “2” or “3”).

4. Culture and development should be considered prior to establishing the action levels. Cultural sensitivity involves considering whether cultural factors are influencing the expression of needs and strengths. Ratings should be completed considering the child/youth’s developmental and/or chronological age depending on the item. In other words, anger control is not relevant for a very young child/youth but would be for an older child/youth or child/youth regardless of developmental age. Alternatively, school achievement should be considered within the framework of expectations based on the child/youth’s developmental age.

5. The ratings are generally “agnostic as to etiology”. In other words this is a descriptive tool; it is about the “what” not the “why”. Only one item, Adjustment to Trauma, has any cause‐effect judgments.

6. A 30‐day window is used for ratings in order to make sure assessments stay “fresh” and relevant to the child/youth’s present circumstances. However, the action levels can be used to over‐ride the 30‐day rating period.

Action Levels for “Need” Items 0 – No Evidence of Need – This rating indicates that there is no reason to believe that a particular need exists. Based on current assessment information there is no reason to assume this is a need. For example, “does Johnny smoke weed?” He says he doesn’t, his mother says he doesn’t, no one else has expressed any concern – does this mean Johnny is not smoking weed? NO, but we have no reason to believe that he does and we would certainly not refer him to programming for substance related problems. 1 ‐ Watchful Waiting/Prevention – This level of rating indicates that you need to keep an eye on this area or think about putting in place some preventive actions to make sure things do not get worse (e.g.


a child/youth who has been suicidal in the past). We know that the best predictor of future behaviour is past behaviour, and that such behaviour may recur under stress, so we would want to keep an eye on it from a preventive point of view. 2 ‐ Action Needed – This level of rating implies that something must be done to address the identified need. The need is sufficiently problematic, that it is interfering in the child/youth’s or family’s life in a notable way. 3 ‐ Immediate/Intensive Action Needed – This level rating indicates a need that requires immediate or intensive effort to address. Dangerous or disabling levels of needs are rated with this level. A child/youth who is not attending school at all or an acutely suicidal child/youth would be rated with a “3” on the relevant need. Action Levels of “Strength” Items 0 ‐ Centerpiece Strength. This rating indicates a domain where strengths exist that can be used as a centerpiece for a strength‐based plan. In other words, the strength‐based plan can be organized around a specific strength in this area.

1 ‐ Useful Strength. This rating indicates a domain where strengths exist and can be included in a strength‐based plan but not as a centerpiece of the plan. 2 ‐ Identified Strength. This rating indicates a domain where strengths have been identified but that they require significant strength building efforts before they can be effectively utilized in a strength‐based plan.

3 ‐ No Strength Identified. This rating indicates a domain in which efforts are needed in order to identify potential strengths for strength building efforts.


EFFECTIVE COMMUNICATION WITH FAMILIES USING THE CANS

Mary Beth Rautkis, Ph.D. Communication happens constantly—even when you are not communicating verbally, you are communicating through your body posture, gestures, eye contact, etc. The CANS is at the heart, a communication tool, and how you communicate when you are working through the CANS is as important as the words on the printed page. Remember, this is not a “form” to be completed, but the reflection of a story that needs to be heard. This section of the manual is about communicating—it applies to the CANS, but it can also be a model for any kind of situation when you need to get and to give information.

Establishing a level of comfort

At a very basic level, people need to feel comfortable in order to share information, and there are ways to promote a feeling of comfort.

Eye contact Different cultures and subcultures, even different individuals have different standards for good eye contact. Try to be sensitive to their level of comfort with eye contact. Eye contact is not staring—it is moving your eyes from the pages to the persons face in a way that feels comfortable for you and for the person you are talking with. You will know if someone is uncomfortable with eye contact—they will not meet your gaze, may look at a point above your head, shift their body etc. It is important to respect this and to shift your gaze to the paper or to another place. If you feel that the individual is comfortable with eye contact, then try to arrange the chairs or table so that you can comfortably move your eyes from the pages to the person that you are talking with.

Personal space

Similarly, people have different degrees of comfort with personal space. You will know what the right distance is—people will let you know verbally or nonverbally if you are in their personal space. Again, it is important to respect these boundaries.

Physical environment

Sometimes this is not within your control, but both of you should be comfortable and able to talk. If the environment is less than ideal, try to find out what would increase the comfort level. For example, in a crowed space you could ask “are you comfortable with this sitting arrangement”?

Self‐awareness

When you are uncomfortable, chances are you are communicating that to the other person. You may fidget, shift, not make eye contact, etc. Someone can only be comfortable if you are comfortable. If you are feeling a sense of discomfort, take a few seconds to think about why that is. Is it the information


that you are receiving? Is it the physical space? Make an effort to find out where your discomfort is coming from and think about how you can make the situation less uncomfortable.

Giving an Overview

Most people like to have a little overview of what will happen in the time you will be spending together and why you will be working together—what will come out of your time together. So, a simple statement like this would be a good way to start: “We’ve been spending some time together talking about (child/youth’s name) and now I’d like us to organize or fit this information together in a way that will help us to come up with a plan that meets your child/youth’s and family’s needs, and that also builds on his/her strong points. We’re going to do this together by using something called the Child and Adolescent Needs and Strengths; we sometimes call it the CANS. You may have looked through this because it is in your family handbook. This helps us to see if you feel something is not a need, if something should be watched, if it should be addressed, and if it should be addressed right now. It also helps us to see if something is a strong point that we can build on, or if it is something that can be built on, and that could become a strong point. It may take us about 45 minutes. Would you like to do the writing or would you like me to?” Sometimes the CANS will just happen “organically”. That is, you will have a “CANS moment”—a time when it just makes sense to start it. That’s great, and sometimes the best exchange of information happens when it is unplanned. However, before you whip out the CANS and sharpen your pencil, be sure to ask the parent, or do a little introduction: “You know what, this is really great information and I’d like us to start writing it down. I’d like to show you something. This is the CANS. . .”

Order of CANS Items

The CANS is organized into parts: you can start with any of the sections—Life Domain Functioning or Mental Health, or Risks or Child/Youth Strengths, or Parent/Caregiver Needs and Strengths. This is your judgment call. Sometimes, people need to talk about needs before they can acknowledge strengths. Sometimes, after talking about strengths, then they can better explain the needs. Trust your judgment, and when in doubt, always ask—“we can start by talking about what you feel that you and your child/youth need, or we can start by talking about the things that are going well and that you want to build on. Do you have a preference?” It is also a good idea to know the CANS. If you are constantly flipping through the pages, or if you read verbatim without shifting your eyes up, it can feel more like an interview than a conversation. A conversation is more likely to give you good information, so have a general idea of the items. Also, some people may “take off” on a topic. The great thing about the CANS is that you can follow their lead. So, if they are talking about anger control and then shift into something like—“you know, he only gets angry when he is in Mr. S’s classroom”, you can follow that and ask some questions about situational anger. So that you are not searching and flipping through papers, have some idea of what page that item is on.


Making the Best Use of the CANS

To increase family involvement, and understanding, encourage the family to look over the CANS prior to the time you sit down to fit it out. The best time is your decision—you will have a sense of the timing as you work with each family. Families often feel respected as partners when they are prepared for a meeting or a process. A copy of the completed CANS should be provided to each family. Encourage families to contact you if they wish to change their answers in any area that they feel needs more or less emphasis.

Listening Using the CANS

Listening is the most important skill that you bring to the CANS. Everyone has an individual style of listening. The better you are at listening, the better the information you will receive. Some things to keep in mind that make you a better listener and that will give you the best information:

Use nonverbal and minimal verbal prompts

Head nodding, smiling and brief “yes”, “and”—things that encourage people to continue

Be nonjudgmental and avoid giving personal advice

You may find yourself thinking “if I were this person, I would do X” or “that’s just like my situation, and I did X”. But since you are not that person, what you would do is not particularly relevant. Avoid making judgmental statements or telling them what you would do. It’s not really about you.

Be empathetic

Empathy is being warm and supportive and acknowledging the feelings of another. It is understanding another person from their own point of reference. You demonstrate empathetic listening when you smile, nod, and maintain eye contact. You also demonstrate empathetic listening when you follow the person’s lead and acknowledge when something may be difficult, or when something is great. You demonstrate empathy when you summarize information correctly. All of this demonstrates to the person you are talking to that you are with them.

Be comfortable with silence

Some people need a little time to get their thoughts together. Sometimes, they struggle with finding the right words. Maybe they are deciding how they want to respond to a question. If you are concerned that the silence means something else, you can always ask “does that make sense to you”? “Or do you need me to explain that in another way”?

Paraphrase and clarify—avoid interpreting

Interpretation is when you go beyond the information given and infer something—in a person’s unconscious motivations, personality, etc. The CANS is not a tool to come up with causes. Rather, it


identifies things that need to be acted upon. Rather than talk about causation, focus on paraphrasing and clarifying. Paraphrasing is restating a message very clearly in a different form, using different words. A paraphrase helps you to (1) find out if you really have understood an answer; (2) clarify what was said, sometimes making things clearer; (3) demonstrate empathy. For example, you ask the questions about health, and the person you are talking to gives a long description. You paraphrase by saying “Ok, it sounds like X, is that right? Would you say that is something that you feel needs to be watched, or is help needed? “

Redirect the conversation to parents’ own feelings and observations

Often, people will make comments about other people’s observations such as “well, my mother thinks that his behaviour is really obnoxious.” It is important to redirect people to talk about their observations: “so your mother feels that when he does X, that is obnoxious. What do YOU think?” The CANS is a tool to organize all points of observation, but the parent or parent/caregiver’s perspective is the most important at the time when you are doing the CANS. Once you have his/her perspective, you can then work on organizing and coalescing the other points of view. Any statements made by others can be noted in the comments section.

Acknowledge feelings People will be talking about difficult things and it is important to acknowledge that. Simple acknowledgement such as “I hear you saying that it can be difficult when . . .” demonstrates empathy.

Wrapping It Up

At the end of the CANS, we recommend the use of two open‐ended questions. These questions ask if there are any past experiences that people want to share that might be of benefit to planning for their child/youth, and if there is anything that they would like to add. This is a good time to see if there is anything “left over”—feelings or thoughts that they would like to share with you. Take time to summarize with the family the areas of strengths and of needs. Help them to get a “total picture” of their child/youth and family, and offer them the opportunity to change any ratings as you summarize or give them the “total picture”. Take a few minutes to talk about what the next steps will be. Now that you have the information organized into a framework, it is time to move into the next stage—planning. You might close with a statement such as: “OK, now the next step is a “brainstorm” where we take this information that we’ve organized and start writing a plan—it is now much clearer which needs must be met and what can be built. So let’s start . . .”


INDIVIDUAL ITEM CODING DEFINITIONS EXECUTIVE FUNCTIONING 1. DECISION‐MAKING SKILLS This item describes the child/youth’s ability to comprehend and anticipate the consequences of decisions; to plan, implement, and monitor a course of action; and to judge and self‐regulate behaviour according to anticipated outcome, in a developmentally appropriate manner.

0 The child/youth has no evidence of problems with decision‐making. 1 The child/youth has mild or occasional problems thinking through problems or situations

but his/her decision‐making abilities do not interfere with functioning. 2 The child/youth has problems with decision‐making and judgment. Difficulties thinking

things through interfere with functioning. 3 The child/youth has severe problems with decision‐making and judgment. Poor decision‐

making places the child/youth at risk. 2. ABILITY TO PAY ATTENTION Problems with attention and staying on task would be rated here.

0 This rating is used to indicate a child/youth who is able to pay attention and stay on task

at a level consistent with age and developmental level. 1 This rating is used to indicate a child/youth with evidence of mild problems with

attention. The child/youth may occasionally have difficulty staying on task for an age‐appropriate time period.

2 This rating is used to indicate a child/youth with evidence of moderate problems with

attention. The child/youth frequently has difficulty staying on task for an age‐appropriate time period.

3 This rating is used to indicate a child/youth with evidence of major problems with

attention. The child/youth is unable to stay on task for an age‐appropriate time period.


EMOTIONAL REGULATION SKILLS 3. SELF‐MANAGEMENT This item refers to the child/youth’s ability to manage his/her emotions and behaviours at a developmentally appropriate level.

0 The child/youth is able to manage emotions and behaviour at a level consistent with age

and developmental level. 1 The child/youth can usually manage emotions and behaviours. The child/youth

occasionally requires external support. 2 The child/youth has moderate problems managing emotions and behaviours. The

child/youth does not maintain control when upset but may respond to external support. 3 The child/youth is having severe problems managing emotions and behaviours. The

child/youth does not respond to external support. 4. MOODINESS These problems include emotional shifts that are not related to immediate events and that result in an inability to fully engage in learning.

0 This rating is given to a child/youth with no difficulties regulating moods. Emotions are

appropriate to the situation and developmental level. 1 This rating is given to a child/youth with some minor difficulties with mood regulation.

This child/youth could have occasional difficulty tolerating intense emotions. The child/youth may deal with this by quietly constricting responses.

2 This rating is given to a child/youth with moderate problems with mood regulation. This

child/youth has difficulty tolerating intense emotions. This child/youth may exhibit marked shifts in emotional responses (e.g. from sadness to irritability to anxiety) or have a tendency to lose control of emotions at various points (e.g. normal moods punctuated by outbursts of anger or sadness). Such shifts are having a negative impact on classroom performance.

3 This rating is given to a child/youth with severe problems with mood regulation. This

child/youth may have rapid shifts in mood and an inability to regulate emotional responses (feeling out of control of his/her emotions or emotionally ‘shutting down’). Such shifts are putting the child/youth at risk of not completing classes.


5. ANGER CONTROL This item captures the child/youth’s ability to identify and manage their anger.

0 This rating indicates a child/youth who appropriately identifies and manages his/her

anger. 1 This rating indicates a child/youth with mild problems controlling anger. He/she may

sometimes become verbally aggressive when frustrated. 2 This rating indicates a child/youth with moderate anger control problems. His/her temper

has gotten him/her in significant trouble with peers, family, and/or school. This level may be associated with some physical aggression.

3 This rating indicates a child/youth with severe anger control problems. His/her temper is

likely associated with frequent fighting that is often physical. Others likely fear him/her. 6. OVER‐REACTION This item reflects a child/youth’s overreaction to certain things (such as people, places, noises) or a constant, heightened degree of arousal. The child/youth may appear overly vigilant. Age and developmental level need to be taken into account.

0 This rating is given to a child/youth with no evidence of overreacting. 1 This rating is given to a child/youth who exhibits some mild problems with overreacting.

This child/youth may exhibit one primary area in which he/she is particularly oversensitive or easily slighted. These behaviours do not have an impact on school performance.

2 This rating is given to a child/youth with moderate symptoms of overreacting. The

child/youth may be consistently on guard and appear unable to relax. The child/youth may occasionally misinterpret social situations and get into arguments with people. These behaviours cause problems with school performance.

3 This rating is given to a child/youth who exhibits significant overreacting. This child/youth

may get easily upset with situations and people, frequently misinterpret social situations or strike out at others. These behaviours put the child/youth at risk of failing in school.


SOCIAL SKILLS 7. SOCIAL FUNCTIONING This item describes the child/youth’s interactions with others. Evidence of problems in this domain may include difficulties responding to adults, difficulty interacting with peers or in social situations, lack of ability to play in groups, relate, or interact in a meaningful manner, unresponsiveness to or unawareness of others, excessive arguing with peers/adults, excessive withdrawal, lack of joy or sustained interaction, aggression, etc.

0 No evidence of problems in social functioning. 1 The child/youth is having some minor problems in social relationships. 2 The child/youth is having moderate problems with his/her social relationships. 3 The child/youth is experiencing severe disruptions in his/her social relationships, showing

an inability to interact in a meaningful manner. 8. BUILDING RELATIONSHIPS This item describes how the child/youth initiates and builds relationships with people. Evidence of problems in this domain may include difficulties starting conversations, entering groups, connecting with people, etc.

0 No evidence of problems in building relationships. 1 The child/youth is having some minor problems in building relationships. 2 The child/youth is having moderate problems in building relationships. 3 The child/youth lacks the basic skills to build relationships.

9. EMPATHY This item describes the child/youth’s ability to empathize with others. Evidence of problems in this domain may include difficulties in appreciating other people’s perspective or point‐of‐view, understanding how his/her behaviour affects other people, taking into consideration how he/she is coming across to other, etc.

0 The child/youth demonstrates appropriate empathy for other child/youth and adults. 1 The child/youth is having some minor problems in demonstrating empathy for other

child/youth and adults. 2 The child/youth is having moderate problems in demonstrating empathy for other

child/youth and adults. 3 The child/youth demonstrates no empathy for other child/youth and adults.


10. SOCIAL PERCEPTION This item describes the child/youth’s ability to accurately perceive social cues. Evidence of problems in this domain may include difficulties in accurately interpreting social cues or detecting social nuances. The child/youth may display inflexible and/or inaccurate interpretations and present cognitive distortions or biases (e.g., “Nobody likes me” “It’s not fair”).

0 No evidence of inaccurate interpretation of social cues and cognitive distortions. 1 The child/youth is having some minor problems with the interpretation of social cues and

is presenting some minor cognitive distortions. 2 The child/youth is having moderate problems with the interpretation of social cues and is

presenting moderate cognitive distortions. 3 The child/youth is unable to interpret social cues and presents significant cognitive

distortions.


ACCULTURATION

11. LANGUAGE This item includes both spoken and sign language

0 There are no language barriers as the child/youth/family speaks English/French well.

1 Child/youth and family speak some English/French but potential communication problems exist due to limits on vocabulary or understanding of the nuances of the language.

2 Child/youth and/or significant family members do not speak English/French. Translator or native language speaker is needed for successful intervention but qualified individual can be identified within natural supports.

3 Child/youth and/or significant family members do not speak English/French. Translator or native language speaker is needed for successful intervention and no such individual is available from among natural supports.

12. IDENTITY Cultural identity refers to the child/youth’s view of him/herself as belonging to a specific cultural group. This cultural group may be defined by a number of factors including race, religion, ethnicity, geography or lifestyle.

0 Child/youth has clear and consistent cultural identity and is connected to others who share his/her cultural identity.

1 Child/youth is experiencing some confusion or concern regarding cultural identity.

2 Child/youth has significant struggles with his/her own cultural identity. Child/youth may have cultural identity but is not connected with others who share this culture.

3 Child/youth has no cultural identity or is experiencing significant problems due to conflict regarding his/her cultural identity.


13. RITUAL Cultural rituals are activities and traditions that are culturally specific including the celebration of culturally specific holidays (Kwanzaa, Cinco de Mayo, etc.). Rituals may also include daily activities that are culturally specific (e.g. praying toward Mecca at specific times, eating a specific diet, access to media).

0 Child/youth and family are consistently able to practice rituals consistent with their

cultural identity. 1 Child/youth and family are generally able to practice rituals consistent with their cultural

identity; however, they sometimes experience some obstacles to the performance of these rituals.

2 Child/youth and family experience significant barriers and are sometimes prevented from

practicing rituals consistent with their cultural identity. 3 Child/youth and family are unable to practice rituals consistent with their cultural

identity. 14. PARENT/CAREGIVER’S CULTURAL STRESS Cultural stress refers to experiences and feelings of discomfort and/or distress arising from friction (real or perceived) between an individual’s own cultural identity and the predominant culture in which he/she lives.

0 No evidence of stress between parent/caregiver’s cultural identify and current living

situation. 1 Some mild or occasional stress resulting from friction between the parent/caregiver’s

cultural identify and his/her current living situation. 2 Caregiver is experiencing cultural stress that is causing problems of functioning in at least

one life domain. Parent/caregiver needs to learn how to manage cultural stress. 3 Caregiver is experiencing a high level of cultural stress that is making functioning in any

life domain difficult under the present circumstances. Parent/caregiver needs immediate plan to reduce cultural stress.


MENTAL HEALTH NEEDS 15. PSYCHOSIS This rating is used to describe symptoms of psychiatric disorders with a known neurological base. The common symptoms of these disorders include psychosis, hallucinations, delusions, unusual thought processes, strange speech, and bizarre/idiosyncratic behaviour.

0 This rating indicates a child/youth with no evidence of thought disturbances. Both thought processes and content are within normal range.

1 This rating indicates a child/youth with evidence of mild disruption in thought processes or content. The child/youth may be somewhat tangential in speech or evidence somewhat illogical thinking (age inappropriate). This also includes a history of hallucinations but none currently.

2 This rating indicates a child/youth with evidence of moderate disturbance in thought processes or content. The child/youth may be somewhat delusional, have brief intermittent hallucinations or speech may be at times quite tangential or illogical.

3 This rating indicates a child/youth with a severe psychotic disorder. Child/youth is fully delusional, has ongoing hallucinations, high levels of paranoia. Unable to engage in meaningful conversation. Symptoms are dangerous to the child/youth or others.

16. ANXIETY Symptoms included in this dimension are those of social anxiety, panic attacks, obsessive‐compulsive disorder, phobias, and separation anxiety.

0 This rating is given to a child/youth with no emotional problems. No evidence of anxiety. 1 This rating is given to a child/youth with mild emotional problems. Brief duration of

anxiety causing mild impairment of peer, family, or academic function that does not lead to gross avoidance behaviour.

2 This rating is given to a child/youth with a moderate level of emotional disturbance. This could include frequent anxiety attacks, obsessions, rituals, hypervigilance, leading to impairment in functioning and social/school avoidance.

3 This rating is given to a child/youth with a severe level of emotional disturbance. This would include a child/youth who stays at home all day due to anxiety or one whose emotional symptoms prevent any participation in school, friendship groups, or family life.


17. MOOD DISTURBANCE Symptoms included in this dimension are symptoms of depressed mood, hypomania, or mania.

0 This rating is given to a child/youth with no mood problems. No evidence of depression,

hypomania or mania. 1 This rating is given to a child/youth with mild mood problems. Brief duration of

depression, irritability, or impairment of peer, family, or academic function that does not lead to gross avoidance or inappropriate behaviour. Mild mood swings with some evidence of hypomania.

2 This rating is given to a child/youth with a moderate level of mood disturbance. This would include anhedonia, episodes of mania, depression, social withdrawal or school avoidance.

3 This rating is given to a child/youth with a severe level of mood disturbance. This would include a child/youth whose emotional symptoms prevent appropriate participation in school, friendship groups, or family life.

18. ATTENTION DEFICIT/HYPERACTIVITY Symptoms of attention deficit and hyperactivity and / or impulse control difficulties would be rated here. Inattention/distractibility not related to opposition would also be rated here.

0 This rating is used to indicate a child/youth with no evidence of attention/hyperactivity

problems.

1 This rating is used to indicate a child/youth with evidence of mild problems with attention and/or hyperactivity. Child/youth may have some difficulties staying on task for an age‐appropriate time period.

2 This rating is used to indicate a child/youth with moderate attention and/or hyperactivity problems that interfere with functioning.

3 This rating is used to indicate a child/youth with severe impairment of attention. Lack of concentration and frequent impulsive behaviour is observed and carries considerable safety risk (e.g. running into the street, dangerous driving or bike riding). A child/youth with profound symptoms of ADHD would be rated here.


19. IMPULSE CONTROL Problems with impulse control would be rated here. These problems may overlap with attention issues.

0 This rating is used to indicate a child/youth who appropriately controls his/her impulses. 1 This rating is used to indicate a child/youth with evidence of mild problems with impulse

control. The child/youth may have occasional difficulties sustaining appropriate behaviour for longer periods.

2 This rating is used to indicate a child/youth with evidence of moderate problems with

impulse control. The child/youth may have difficulties sustaining appropriate behaviour for shorter periods.

3 This rating is used to indicate a child/youth with severe impulse control problems.

Frequent impulsive behaviour is observed or noted that carries considerable safety risk (e.g. running into the street or hitting other children/child/youth without thinking about it).

20. EATING DISTURBANCE These symptoms relate to problems with eating including disturbances in appetite and intake as well as eating disturbances related to body image (refusal to maintain normal body weight and recurrent episodes of binge eating).

0 This rating is for a child/youth with no evidence of eating disturbances. 1 This rating is for a child/youth with a mild level of eating disturbance. This includes a

child/youth that has a poor appetite or is a picky eater, or a child/youth that frequently overeats. This could also include some preoccupation with weight, calorie intake, or body size or type. This could also include some binge eating patterns.

2 This rating is for a child/youth with a moderate level of eating disturbance. This includes a

child/youth whose appetite/intake or lack thereof requires intervention (refuses to eat, consistently overeating). This could also include a more intense preoccupation with weight gain or becoming fat when underweight, restrictive eating habits or excessive exercising in order to maintain below normal weight, and/or emaciated body appearance. This level could also include more notable binge eating episodes that are followed by compensatory behaviours in order to prevent weight gain (e.g., vomiting, use of laxatives, excessive exercising).

3 This rating is for a child/youth with a severe form of an eating disturbance. This could

include significantly low weight / restricted intake / or excessive binge‐purge behaviours (at least once per day), leading to a need for hospitalization.


21. OPPOSITIONAL BEHAVIOUR (COMPLIANCE WITH AUTHORITY) This rating is intended to capture how the child/youth relates to authority. Oppositional behaviour is different from conduct disorder in that the emphasis of the behaviour is on non‐compliance to authority rather than on seriously breaking social rules, norms and laws.

0 This rating indicates that the child/youth is generally compliant.

1 This rating indicates that the child/youth has mild problems with compliance to some rules or adult instructions.

2 This rating indicates that the child/youth has moderate problems with compliance to rules or adult instructions.

3 This rating indicates that the child/youth has severe problems with compliance to rules and adult instructions. He/she is virtually always disobedient.

22. CONDUCT BEHAVIOUR (COMPLIANCE WITH SOCIETY’S RULES) These symptoms include antisocial behaviours like shoplifting, lying, vandalism, cruelty to animals, and assault.

0 This rating indicates a child/youth with no evidence of behaviour disorder.

1 This rating indicates a child/youth with a mild level of conduct problems. Some antisocial behaviour in school and/or home. Problems recognizable but not notably deviant for age and sex and community. This might include occasional truancy, lying, or petty theft from family.

2 This rating indicates a child/youth with a moderate level of conduct disorder. This could include episodes of planned aggressive or other anti‐social behaviour.

3 This rating indicates a child/youth with a severe antisocial behaviour. This could include frequent episodes of unprovoked, planned aggressive or other anti‐social behaviour.


23. ADJUSTMENT TO TRAUMA/ TRAUMATIC LIFE EXPERIENCES This rating covers the reactions of child/youth to any life experience that the child/youth perceives as traumatic. This includes events such as abuse, neglect, loss of a significant relationship, separation from family, death of family member or witnessing violence. Adjustment disorders feature a psychological response to a single or multiple identifiable stressors that results in the development of clinically significant emotional and / or behavioural symptoms.

0 Child/youth has not experienced any significant traumatic life events.

1 History of abuse, neglect, separation or loss to which child/youth has adjusted well. Child/youth does not show any current significant physical or emotional impairment.

2 Child/youth has marked adjustment problems associated with past or ongoing abuse, neglect, trauma or stressor. Child/youth has notable symptoms of grief, depression, anxiety or disturbances in conduct related to adjustment difficulties. May experience intrusive thoughts related to trauma or flashbacks.

3 Child/youth functioning is severely impaired by prolonged or severe levels of grief, depression, anxiety or disturbances in conduct directly related to abuse, trauma or stressors experienced. Frequent and debilitating flashbacks or dissociative episodes would be rated here.


24. ATTACHMENT DIFFICULTIES This item should be rated within the context of the child/youth’s significant parental or parent/caregiver relationships. Separation anxiety should be rated under Anxiety.

0 No evidence of attachment problems. Parent/caregiver‐child/youth relationship is

characterized by mutual satisfaction of needs and child/youth’s development of a sense of security and trust. Parent/caregiver appears able to respond to child/youth’s cues in a consistent, appropriate manner, and child/youth seeks age‐appropriate contact with parent/caregiver for both nurturing and safety needs.

1 Mild problems with attachment. There is some evidence of insecurity in the child/youth ‐caregiver relationship. Parent/caregiver may at times have difficulty accurately reading child/youth bids for attention and nurturance; may be inconsistent in response; or may be occasionally intrusive. Child/youth may have mild problems with separation (e.g., anxious/clingy behaviours in the absence of obvious cues of danger) or may avoid contact with parent/caregiver in age‐inappropriate way. Child/youth may have minor difficulties with appropriate physical/emotional boundaries with others.

2 Moderate problems with attachment. Attachment relationship is marked by sufficient difficulty as to require intervention. Parent/caregiver may consistently misinterpret child/youth cues, act in an overly intrusive way, or ignore/avoid child/youth bids for attention/nurturance. Child/youth may have ongoing difficulties with separation, may consistently avoid contact with parent/caregiver, and may have ongoing difficulties with physical or emotional boundaries with others.

3 Severe problems with attachment. Child/youth is unable to form attachment relationships with others (e.g. chronic dismissive/ avoidant/ detached behaviour in care giving relationships) OR child/youth presents with diffuse emotional/physical boundaries leading to indiscriminate attachment with others. Child/youth is considered at ongoing risk due to the nature of his/her attachment behaviours. Child/youth may have experienced significant early separation from or loss of parent/caregiver, or have experienced chronic inadequate care from early parent/caregiver s, or child/youth may have individual vulnerabilities (e.g. mental health, developmental disabilities) that interfere with the formation of positive attachment relationships.


25. SUBSTANCE USE These symptoms include use of alcohol and illegal drugs, the misuse of prescription medications and the inhalation of any substance for recreational purposes.

0 This rating is for a child/youth who has no substance use difficulties at the present time. If

the person is in recovery for greater than 1 year, he/she should be coded here, although this is unlikely for a child/youth.

1 This rating is for a child/youth with mild substance use problems that might occasionally present problems for the child/youth (intoxication, loss of money, reduced school performance, parental concern). This rating would be used for someone early in recovery (less than 1 year) who is currently abstinent for at least 30 days.

2 This rating is for a child/youth with a moderate substance abuse problem that exacerbates the psychiatric illness and therefore requires treatment. Substance abuse problems consistently interfere with the ability to function optimally but do not completely preclude functioning in an unstructured setting.

3 This rating is for a child/youth with a severe substance dependence condition that presents a significant complication to the coordination of care (e.g. need for detoxification) of the individual.

26. AUTISM SPECTRUM/PDD This rating describes symptoms of pervasive developmental disorders.

0 No evidence of a pervasive developmental disorder. 1 Evidence of a mild pervasive developmental disorder. A child/youth here may have

symptoms of a developmental disorder but those symptoms are below the threshold for a PDD diagnosis and do not have a significant effect on the child/youth’s development.

2 This rating indicates a child/youth who meets criteria for a pervasive developmental

disorder including Autism, Asperger’s, PDD NOS, Rett’s, and child/youth Disintegrative Disorder. This child/youth’s development creates significant challenges.

3 Severe pervasive developmental disorder. Child/youth is unable to meet developmental

milestones.


27. PARENT‐CHILD/YOUTH RELATIONAL PROBLEMS This rating captures the pattern of interaction between parent and child/youth (e.g., communication, discipline methods, parenting approach, conflict resolution).

0 Parent and child/youth have healthy patterns of communication and conflict resolution. Parenting style and discipline methods are appropriate for age and needs of child/youth.

1 Parent and child/youth have some difficulty communicating and there may be unresolved

conflict between parent and child/youth. Parenting style may be overprotective or overly permissive and discipline methods may be quite strict or quite lax. The family is able to overcome these tensions sufficiently to continue to function as a family.

2 Parent and child/youth struggle to communicate most of the time. Unresolved conflict

remains a significant source of stress in the household. Parenting style and / or discipline methods negatively impact on the emotional health of the child/youth.

3 There is a total lack of communication between parent and child/youth. Parent and

child/youth conflict in most interactions. Parenting style and / or discipline method put the emotional or physical health and safety of the child/youth at risk.


RISK BEHAVIOURS 28. SUICIDE RISK This rating describes suicidal behaviour. A rating of 2 or 3 would indicate the need for a safety plan.

0 Child/youth has no recent history or current evidence of suicidal thoughts or behaviour.

Does not communicate any current suicidal ideation or plan.

1 History of suicidal gestures or attempts but not during the past 30 days. Or no history of attempts but communicates passive suicidal ideation without current intent or plan.

2 Recent suicidal gesture or attempt in the last 30 days but none today. Or, a child/youth with no planned attempt but with constant intrusive, ruminating thoughts of suicide.

3 Suicidal gesture (attempt) in the last 24 hours. Or no attempt but child/youth communicates current suicidal intent with plan to attempt.

29. SELF‐INJURING BEHAVIOURS This rating is used for any intentional self‐harming behaviour that does not have a suicidal intent. A rating of 3 indicates need for a safety plan.

0 No history of self‐injuring behaviour. 1 A history of self‐injuring behaviour but none within the past 30 days or minor self‐injuring

behaviour (i.e., scratching) in the last 30 days that does not require any medical attention. 2 Moderate self‐injuring behaviour in the last 30 days requiring medical assessment

(cutting, burns, piercing skin with sharp objects, repeated head banging) that has potential to cause safety risk to child/youth.

3 One or more incidents of self‐injuring behaviour in the last 30 days requiring medical

intervention (i.e., sutures, surgery) and that is significant enough to put child/youth’s health at risk.


30. OTHER SELF HARM This item refers to reckless behaviour that does or would likely result in physical harm.

0 No evidence of behaviours other than suicide or self‐mutilation that place the child/youth at risk of physical harm.

1 History of behaviour other than suicide or self‐mutilation that places child/youth at some

risk of physical harm. This includes reckless and risk‐taking behaviour that may endanger the child/youth.

2 Engaged in behaviour other than suicide or self‐mutilation that places him/her in serious

danger of physical harm. This includes reckless behaviour or intentional risk‐taking behaviour.

3 Engaged in behaviour other than suicide or self‐mutilation that places him/her at

immediate risk of death. This includes reckless behaviour or intentional risk‐taking behaviour.

31. AGGRESSION TOWARDS OBJECTS This rating includes only physical violence.

0 The child/youth has no evidence of aggressive behaviours or significant physical aggression towards objects.

1 History of aggressive behaviour toward objects but no aggression during the past 30 days. 2 Occasional or moderate level of aggression towards objects during the past 30 days, such

as slamming doors, throwing things, etc. 3 Frequent or dangerous (significant harm) level of aggression to objects (resulting in

significant property damage). 32. CRUELTY TO ANIMALS This rating includes any violence directed towards animals.

0 The child/youth has no evidence of cruel behaviour directed towards animals.

1 History of notable cruelty to animals but none during the past 30 days.

2 Occasional or moderate level of cruelty to animals during the past 30 days, aggressive

teasing, hitting, kicking, etc.

3 Frequent or dangerous (significant harm) level of cruelty to animals resulting in significant injury or death to the animal(s).


33. DANGER TO OTHERS This rating includes actual and threatened violence. Imagined violence, when extreme, may be rated here. A rating of 2 or 3 would indicate the need for a safety plan.

0 Child/youth has no evidence or history of aggressive behaviours or significant verbal aggression towards others (including people and animals).

1 History of aggressive behaviour or verbal aggression towards others but no aggression during the past 30 days. History of fire setting (not in past year) would be rated here. Or a child/youth who communicates passive homicidal ideation without clear intent or plan.

2 Occasional or moderate level of aggression towards others during the past 30 days. Or a child/youth with no defined plan but who has constant intrusive, ruminating thoughts of homicide or extreme violence.

3 Frequent or dangerous (significant harm) level of aggression to others. Any fire setting within the past year would be rated here. Child/youth is an immediate risk to others. Verbalization of homicidal ideation with clear intent, means and plan.

34. SEXUAL AGGRESSION Sexually aggressive behaviour includes both abusive sexual behaviour and sexual behaviour in which the child/youth takes advantage of a younger or less powerful child/youth through seduction, coercion, or force. This rating refers to perpetrating the sexual behaviour.

0 No evidence of problems with sexual behaviour in the past year.

1 Mild problems of sexually aggressive behaviour. For example, some inappropriate and aggressive sexual behaviour or language directed at others, without physical contact.

2 Moderate problems with sexually abusive behaviour, inappropriate sexual behaviour and language causing significant distress, discomfort for others. Frequent disrobing would be rated here only if it was sexually provocative.

3 Severe problems with sexual aggression / behaviour. Unwanted or coerced sexual activity would be rated here. This would include the rape or sexual abuse of another person.


35. ELOPEMENT/RUNAWAY This rating refers to any planned or impulsive running behaviour that presents a risk to the safety of the child/youth. Factors to consider in determining level of risk include age of child/youth, frequency and duration of running episodes, choice and safety of destination, involvement in risky activities while on the run, impulsivity, and involvement of others in elopement plans.

0 This rating is for a child/youth with no history of running away and no ideation involving

escaping from the present living situation.

1 This rating is for a child/youth with a history of running away but none in the past month. Or a child/youth who expresses ideation about escaping present living situation or has threatened to run. This rating may also include a child/youth who impulsively leaves home / current living situation for a few hours, but returns voluntarily prior to night.

2 This rating is for a child/youth who has run away from home / current living situation within the past 30 days. Running behaviour creates concern for the safety of the child/youth.

3 This rating is for a child/youth who has run away from home or living situation within the last week; or run away from home setting and stayed away overnight during the past 30 days. Destination is not a return to home of parent or relative. Running behaviour places the safety of the child/youth at significant risk.

36. DELINQUENT BEHAVIOUR This rating includes both criminal behaviour and delinquent behaviour that may result from child/youth failing to follow required behavioural standards (e.g. truancy). Sexual offences should be included as criminal behaviour.

0 Child/youth shows no evidence or has no history of criminal or delinquent behaviour.

1 History of criminal activity but none in the past 30 days. No current outstanding charges for serious offences committed more than 30 days ago. Delinquent behaviour (i.e. truancy, running away, behaviourally out of control) in the last 30 days would be rated here.

2 Moderate level of criminal activity including charges or a high likelihood of crimes committed in the last 30 days. Examples would include vandalism, shoplifting, drug possession etc. Or a child/youth awaiting trial for serious charges.

3 Serious level of criminal activity in the last 30 days. Examples would include assault, car theft, residential burglary, gang activity, sexual offences etc.


37. FIRE SETTING This item refers to behaviour involving the intentional setting of fires that might be dangerous to the child/youth or others. This does not include the use of candles, incense or matches to smoke.

0 No evidence or relevant history of fire setting behaviour. 1 History of fire setting but not in the past six months. 2 Recent fire setting behaviour (in past six months) but not of the type that has endangered

the lives of others OR repeated fire‐setting behaviour over a period of at least two years even if not in the past six months.

3 Acute threat of fire setting. Set fire that endangered the lives of others (e.g. attempting

to burn down a house). 38. INTENTIONAL MISBEHAVIOUR This rating refers to a child/youth who purposefully gets into trouble to select one sanction over another.

0 No evidence of problematic social behaviour. Child/youth does not engage in behaviour that forces adults to sanction him/her.

1 Mild level of problematic social behaviour. This might include occasional inappropriate

social behaviour that forces adults to sanction the child. Infrequent inappropriate comments to strangers or unusual behaviour in social settings might be included in this level. This rating indicates a child/youth who may go along with some risky peer behaviours.

2 Moderate level of problematic social behaviour. Social behaviour is causing problems in

the child’s life. Child may be intentionally getting in trouble in school or at home. Easily influenced to engage in risky behaviours. Current social behaviour places the child/youth at risk.

3 Severe level of problematic social behaviour. This level would be indicated by frequent

serious social behaviour that forces adults to seriously and/or repeatedly sanction the child. Social behaviours are sufficiently severe that they place the child at risk of significant sanctions (e.g. expulsion, removal from the community) and may place the child at high risk of being victimized.


39. BULLYING This item refers only to the child/youth who is the bully.

0 Child/youth has never engaged in bullying at school or in the community. 1 Child/youth has been involved with groups that have bullied other child/youth either in

school or the community; however, child/youth has not had a leadership role in these groups.

2 Child/youth has bullied other child/youth in school or community. Child/youth has either

bullied the other child/youth individually or led a group that bullied youth. 3 Child/youth has repeatedly utilized threats or actual violence to bully child/youth in

school and/or community.


EDUCATIONAL NEEDS 40. SCHOOL ATTENDANCE This item describes the child/youth’s attendance at school.

0 No evidence of attendance problems. The child/youth attends regularly. 1 The child/youth has some problems attending school, although he/she generally goes to

school. He/she may have one or two excused absences per month. 2 The child/youth is currently having problems with school attendance. He/she may have

one or two unexcused absences in a month. 3 The child/youth is missing school on a weekly basis or more, whether excused or

unexcused. 41. CLASSROOM BEHAVIOUR This item describes the child/youth’s disruptive behaviour while in class.

0 The child/youth participates appropriately in classes and is not disruptive. 1 The child/youth does not participate in classes but is not disruptive. 2 The child/youth is occasionally disruptive in classes. 3 The child/youth’s behaviour regularly disrupts classes.

42. NON‐CLASSROOM BEHAVIOUR This item describes the child/youth’s behaviour in school, outside the classroom setting. The child/youth may be either the initiator or the responder.

0 The child/youth gets through non‐classroom tasks (i.e. lunch, study hall, passing through

hallways) without incidents. 1 The child/youth gets through non‐classroom tasks (i.e. lunch, study hall, passing through

hallways) with occasional minor incidents, such as an argument. 2 The child/youth has minor incidents weekly during non‐classroom tasks (i.e. lunch, study

hall, passing through hallways). 3 The child/youth had a major incident in the past month, such as a physical fight, during

non‐classroom tasks (i.e. lunch, study hall, passing through hallways).


43. COMPLIANCE TO SCHOOL DISCIPLINE This item rates the overall behaviour problems of the child/youth at school .

0 No evidence of behaviour problems at school. No discipline referrals have occurred this

school year. 1 Mild problems with school behaviour. A single office referral for discipline might be rated

here. 2 The child/youth is having moderate behavioural difficulties at school. He/she is disruptive

and may receive sanctions including a suspension or multiple detentions. 3 The child/youth is having severe problems with behaviour in school. He/she is frequently

or severely disruptive and has received several sanctions. School placement may be in jeopardy due to behaviour.

44. ACADEMIC ACHIEVEMENT This item describes academic achievement based on school grades and compares this child/youth to other classmates in that school, taking into consideration if the child/youth has an Individual Education Plan (IEP), rather than comparing to national norms.

0 The child/youth is doing adequately in school academically. 1 The child/youth struggles with some academics but is passing with a C average and no

failed classes. 2 The child/youth is having problems with school academically. He/she has a C average but

is failing one subject. 3 The child/youth is having severe academic problems. He/she is failing more than one

subject or is more than a year behind his/her peers at this school in academic achievement.

45. ACADEMIC PERSISTENCE This rating should be based broadly on the child/youth’s overall efforts to persist, regardless of outcome.

0 This level indicates a child/youth with academic persistence. For example, a child/youth

who takes on assignments and asks for assistance when needed would be rated here. 1 This level indicates a child/youth who is developing appropriate academic persistence. A

child/youth who tries but needs to learn when to ask for assistance would be rated here. 2 This level indicates a child/youth whose academic persistence is inconsistent. This

child/youth initially attempts tasks but gives up and does not complete assignments. 3 This level indicates a child/youth whose academic persistence is inadequate. This

child/youth does not take on assignments or has refused assistance.


46. LEARNING DISABILITY This rating describes the child/youth’s academic performance in school.

0 The child/youth has no difficulties with academic achievement and is doing well in school.

The child/youth has no identified learning disabilities. 1 The child/youth is doing adequately in school, although some problem with achievement

exists. Or a child/youth with a learning disability who is achieving well with supports in place.

2 The child/youth is having moderate problems with school achievement and is unable to

manage expected work. This would include a child/youth with a diagnosed learning disability who is struggling with achievement.

3 The child/youth is having severe achievement problems. He/she may be failing most

subjects or is more than one year behind same age peers in school achievement. May or may not have a learning disability.

47. SPECIAL EDUCATION This item describes the involvement of the child/youth with Special Education services.

0 The child/youth is not involved with Special Education services. 1 The child/youth has been referred for an evaluation for Special Education services. 2 The child/youth is receiving Special Education services. 3 The child/youth is not responding to current Special Education services.

48. INTELLECTUAL This rating describes the child/youth’s cognitive/intellectual functioning.

0 The child/youth’s intellectual functioning appears to be in normal range. There is no

reason to believe that the child/youth has any problems with intellectual functioning. 1 Borderline to low average IQ (IQ between 70 and 90). 2 Mild to moderate delayed intellectual functioning (IQ between 50 and 70). 3 Severe or profound delayed intellectual functioning (IQ less than 50).


YOUTH JUSTICE 49. SERIOUSNESS Please rate the highest level from the past 30 days.

0 Child/youth has engaged only in status violations (e.g. curfew). 1 Child/youth has engaged in delinquent behaviour. 2 Child/youth has engaged in criminal behaviour. 3 Child/youth has engaged in criminal behaviour that places other citizens at risk of

significant physical harm.

50. HISTORY Please rate using time frames provided in the anchors.

0 Current criminal/delinquent behaviour is the first known occurrence in the past year. 1 Child/youth has engaged in multiple criminal/delinquent acts in the past one year. 2 Child/youth has engaged in multiple criminal/delinquent acts for more than one year but

has had periods of at least 3 months where he/she did not engage in delinquent behaviour.

3 Child/youth has engaged in multiple criminal/delinquent acts for more than one year

without any period of at least 3 months where he/she did not engage in criminal or delinquent behaviour.

51. ARRESTS Please rate the highest level from the past 30 days.

0 Child/youth has no known arrests in past 30 days. 1 Child/youth has history of delinquency, but no arrests past 30 days. 2 Child/youth has 1 or 2 arrests in last 30 days. 3 Child/youth has more than 2 arrests in last 30 days.


52. PLANNING Please rate the highest level from the past 30 days.

0 No evidence of any planning. Criminal/delinquent behaviour appears opportunistic or

impulsive. 1 Evidence suggests that child/youth places him/herself into situations where the likelihood

of criminal/delinquent behaviour is enhanced. 2 Evidence of some planning of criminal/delinquent behaviour. 3 Considerable evidence of significant planning of criminal/delinquent behaviour. Behaviour

is clearly premeditated. 53. COMMUNITY SAFETY Please rate the highest level from the past 30 days.

0 Child/youth presents no risk to the community. He/she could be unsupervised in the

community. 1 Child/youth engages in behaviour that represents a risk to community property. 2 Child/youth engages in behaviour that places community residents in some danger of

physical harm. This danger may be an indirect effect of the youth’s behaviour. 3 Child/youth engages in behaviour that directly places community members in danger of

significant physical harm. 54. LEGAL COMPLIANCE Please rate the highest level from the past 30 days.

0 Child/youth is fully compliant with all responsibilities imposed by the court (e.g. school

attendance, treatment, restraining orders) or no court orders are currently in place. 1 Child/youth is in general compliance with responsibilities imposed by the court (e.g.

occasionally missed appointments). 2 Child/youth is in partial noncompliance with standing court orders (e.g. child/youth is

going to school but not attending court‐order treatment). 3 Child/youth is in serious and/or complete noncompliance with standing court orders (e.g.

probation violations).


55. PEER INFLUENCES Please rate the highest level from the past 30 days.

0 Youth’s primary peer social network does not engage in criminal/delinquent behaviour. 1 Child/youth has peers in his/her primary peer social network who do not engage in

criminal/delinquent behaviour but has some peers who do. 2 Child/youth predominantly has peers who engage in delinquent behaviour but

child/youth is not a member of a gang. 3 Child/youth is a member of a gang whose membership encourages or requires illegal

behaviour as an aspect of gang membership.

56. PARENTAL CRIMINAL BEHAVIOUR Please rate the highest level from the past 30 days.

0 There is no evidence that youth’s parents/caregivers have ever engaged in

criminal/delinquent behaviour. 1 One of youth’s parents/caregivers has history of criminal/delinquent behaviour but

child/youth has not been in contact with this parent for at least one year. 2 One of youth’s parents has history of criminal/delinquent behaviour and child/youth has

been in contact with this parent in the past year. 3 Both of youth’s parents/caregivers have history of criminal/delinquent behaviour.

57. ENVIRONMENTAL INFLUENCES Please rate the environment around the youth’s living situation.

0 No evidence that the child/youth’s environment stimulates or exposes the child/youth to

and criminal/delinquent behaviour. 1 Mild problems in the child/youth’s environment stimulate or expose the child/youth to

any criminal/delinquent behaviour. 2 Moderate problems in the child/youth’s environment that clearly expose the child/youth

to criminal/delinquent behaviour. 3 Severe problems in the child/youth’s environment that stimulate the child/youth to

engage in criminal/delinquent behaviour.


CHILD/YOUTH INDIVIDUAL STRENGTHS 58. TALENTS/INTERESTS This rating should be based broadly on any talent, athletic ability, creative interests or artistic skill a child/youth may have including art, theatre, music, athletics, etc.

0 This level indicates a child/youth with significant and multiple creative/artistic/athletic strengths. A child/youth who receives a significant amount of personal benefit from activities surrounding a talent/athletic ability would be rated here. This may be a child/youth who has learned to use his/her talent or interest to cope with difficulties.

1 This level indicates a child/youth with a notable talent/athletic ability. For example, a

child/youth who is involved in sports or plays a musical instrument, etc. would be rated here.

2 This level indicates a child/youth who has expressed interest in developing a specific

talent(s)/ability(ies) even if they have not developed that talent/ability to date. 3 This level indicates a child/youth who has not identified any current interests or hobbies.

59. EXTRA‐CURRICULAR ACTIVITIES This item describes a child/youth’s participation in extra‐curricular activities (in school or in the community).

0 Child/youth takes on a leadership role in extra curricular activities. 1 Child/youth actively participates in extra curricular activities. 2 Child/youth participates somewhat, or on an irregular basis, in extra curricular activities. 3 Child/youth does not participate in extra curricular activities.

60. OPTIMISM This rating should be based on the child/youth's sense of him/herself in his/her own future. This is intended to rate the child/youth’s positive future orientation.

0 Child/youth has a strong and stable optimistic outlook on his/her life. Child/youth is future oriented.

1 Child/youth is generally optimistic. Child/youth is likely able to articulate some positive

future vision. 2 Child/youth has difficulties maintaining a positive view of his/her life with regards to the

future. Child/youth may vary from overly optimistic to overly pessimistic. Child/youth may be ambivalent re: future.

3 Child/youth has difficulty seeing any positives about his/her life in the future.


61. LEADERSHIP Leadership refers to the child/youth’s ability to accept individual responsibility, organize peers and inspire others. A child/youth may demonstrate leadership potential even though that child/youth does not always use such skills in a positive way.

0 This level indicates a child/youth with significant leadership strengths. A child/youth who

is regularly recognized by adults or is acknowledged as a positive leader by peers. 1 This level indicates a child/youth with a notable leadership talent. For example, a

child/youth who is elected team captain or class representative. This may also include a child/youth who is recognized as a leader by his or her peers, even though the student does not always use such leadership skills to reach a positive outcome.

2 This level indicates a child/youth who accepts some or expresses interest in leadership

roles (e.g. runs for student council) even if those roles have not developed to date. 3 This level indicates a child/youth who does not express interest in leadership roles.

62. CREATIVITY/IMAGINATION This item rates the child/youth’s ability to solve problems and develop new ideas.

0 Significant level of creativity/imagination. The child/youth consistently demonstrates

strong skills in this area. 1 Moderate level of creativity/imagination. The child/youth usually demonstrates good

skills in creativity/imagination but continues to need development in this area. 2 Mild level of creativity/imagination. The child/youth usually demonstrates only marginal

skills in creativity/imagination but can be encouraged in this area by adults. 3 This level indicates a child/youth with no known skills in creativity/imagination. Adults

are minimally able to impact the child/youth’s skills in this area.


63. PEER RELATIONS This rating refers to the interpersonal skills of the child/youth or child/youth with same age peers.

0 Significant interpersonal strengths. Child/youth is seen as well liked by others and has

significant ability to form and maintain positive relationships with peers. Child/youth has multiple close friends and is friendly with others.

1 Moderate level of interpersonal strengths. Child/youth has formed positive interpersonal relationships with peers. Child/youth may have one friend, if that friendship is a healthy ‘best friendship’ model.

2 Mild level of interpersonal strengths. Child/youth has some social skills that facilitate positive relationships with peers; may not have any current relationships, but has a history of making and maintaining healthy friendships with others.

3 This level indicates a child/youth with no known interpersonal strengths. Child/youth currently does not have any friends nor has he/she had any friends in the past. Child/youth does not have positive relationships with peers.

64. SELF EXPRESSION This rating refers to a child/youth’s ability to identify and express his/her thoughts and feelings. Expression may be in a variety of ways (i.e. written, verbal, artistic). Examples include poetry, song lyrics, art, dance etc.

0 This rating would be used for a child/youth who is able to clearly identify and express

his/her feelings. A child/youth here feels understood, as he/she has found a vehicle through which he/she can articulate and share his/her thoughts and feelings with others around them.

1 This child/youth is sometimes able to identify and express thoughts and feelings. A

child/youth here may keep a journal or confide in others but does not always feel as though he/she is able to make him/herself clearly understood.

2 A child/youth at this level has considerable difficulty identifying or expressing how he/she

thinks and feels, and may feel as though his/her thoughts/feelings are frequently misinterpreted/misunderstood. A child/youth here may currently internalize most of his/her thoughts/emotions or express all as only one emotion (i.e. anger) but showed evidence in the past of having been able to express self.

3 A child/youth here shows no evidence of capability to express how they think or feel,

causing significant frustration / stress for child/youth. A child/youth here may feel completely misunderstood and alone. Child/youth has never been able to express self.


65. FLEXIBILITY/ADAPTABILITY TO CHANGE This rating refers to a child/youth’s ability to adapt to change and to resolve feelings related to difficult experiences in his/her life and routine.

0 Child/youth is flexible and is able to easily resolve feelings/emotions related to changes in

his/her life. Adapts well when changes are made to usual routine. 1 This rating refers to a child/youth who may have mild difficulties adapting to change or

who requires a moderate level of support to process alterations in routine or life changes. No long‐term difficulties.

2 Child/youth has significant difficulty adjusting to changes in his/her life. Requires ongoing

or intensive support to resolve feelings and emotions related to change. Change may be a known trigger for this child/youth.

3 Child/youth shows no evidence of ability to adapt to changes occurring in his/her life or

routine or to deal with unresolved feelings/emotions related to the changes. 66. LIFE SKILLS This rating should be based on the child/youth’s ability to complete the tasks required for independent living such as money management, managing transportation and medication, cooking, cleaning, etc.

0 This level indicates a child/youth who has fully developed living skills and could live independently at this time.

1 This level indicates a child/youth with significant living skills that provide autonomy to the

child/youth and facilitate caregiving. 2 This level indicates a child/youth with some living skills. 3 This level indicates a child/youth with no developed living skills. Child/youth is fully

dependent on a parent/caregiver for all of these tasks.

67. RESILIENCY This rating should be based on the child/youth’s ability to identify and use internal strengths in managing his/her life.

0 This level indicates a child/youth who is able to both identify and use strengths to better

themselves and successfully manage difficult challenges. 1 This level indicates a child/youth who is able to identify most of his/her strengths and is

able to partially utilize them. 2 This level indicates a child/youth who is able to identify strengths but is not able to utilize

them effectively. 3 This level indicates a child/youth who is not yet able to identify personal strengths.


CHILD/YOUTH ENVIRONMENTAL STRENGTHS 68. FAMILY Family refers to all biological or adoptive relatives with whom the child/youth remains in contact along with other individuals in relationships with these relatives.

0 Significant family strengths. This level indicates a family with much love and mutual respect

for each other. Family members are central in each other's lives. Child/youth is fully included in family activities.

1 Moderate level of family strengths. This level indicates a loving family with generally good communication and ability to enjoy each other's company. There may be mild problems between family members. Child/youth is generally included.

2 Mild level of family strengths. Family is able to communicate and participate in each other's lives; however, family members may not be able to provide significant emotional or concrete support for each other. Child/youth is often not included in family activities.

3 This level indicates a child/youth with no known family strengths. Child/youth is not included in normal family activities.

69. NATURAL SUPPORTS This item refers to unpaid others who help out in times of need.

0 Child/youth has significant natural supports. Multiple friends and neighbours routinely

provide support for the family. 1 Child/youth has some natural supports. Unpaid others will help out in times of need. 2 Child/youth has friends and neighbours but it is not know whether they would be willing

to help. 3 Child/youth has have no natural supports.


70. COMMUNITY INVOLVEMENT This rating should be based on the child/ youth’s level of involvement in his/her community.

0 This level indicates a child/youth with extensive and substantial, long‐term (i.e. more than

one year) ties with the community. For example, individual may be an active member of one or more organized community groups (e.g. sports team, volunteer service, child/youth group, student councils), or involved in other community activities, informal networks, etc.

1 This level indicates a child/youth with significant community ties although they may be relatively short term (e.g. past year). This would include joining one community group / sports team or being involved in one community organization.

2 This level indicates a child/youth with limited ties and/or involvement in the community. This would include a child/youth who has expressed interest in joining a community organization.

3 This level indicates a child/youth with no known involvement or interest in his/her community.

71. CULTURAL IDENTITY Cultural identify refers to the child/youth’s view of him/herself as belonging to a specific cultural group. This cultural group may be defined by a number of factors including race, religion, ethnicity, geography or lifestyle.

0 The child/youth has a cultural identity and is connected to others who support his/her cultural identity.

1 The child/youth is developing a cultural identity and is seeking others to support his/her

cultural identity. 2 The child/youth is searching for a cultural identity and has not connected with others. 3 The child/youth does not express a cultural identity.

72. RESOURCEFULNESS This rating should be based on the child/youth’s ability to identify and use external strengths in managing his/her life.

0 This level indicates a child/youth who is able to both identify and use external strengths to

better him/herself and successfully manage difficult challenges. 1 This level indicates a child/youth who able to identify most of his/her external strengths

and is able to partially utilize them. 2 This level indicates a child/youth who is able to identify external strengths but is not able

to utilize them effectively. 3 This level indicates a child/youth who is not yet able to identify external strengths.


PARENT/FAMILY/CAREGIVER NEEDS AND STRENGTHS Caregiver refers to parent(s) or other adult with primary care‐taking responsibilities for the child/youth.

73. DISCIPLINE/PARENTING SKILLS This item describes the parents’ ability to appropriately discipline their child/youth and apply effective parenting techniques (e.g., ability to set rules, give consequences and rewards, cohesion between parents, etc).

0 The parents/caregivers are able to appropriately discipline their child/youth and use

effective parenting techniques. 1 The parents/caregivers have some difficulties with appropriately disciplining their

child/youth and using effective parenting techniques (for example, parents/caregivers may sometimes be inconsistent or not always agree on consequences).

2 The parents/caregivers have significant difficulties appropriately disciplining their

child/youth. They have limited parenting techniques and/or are using ineffective parenting techniques.

3 The parents/caregivers are unable to discipline their child/youth or they are using

inappropriate parenting techniques. 74. SUPERVISION This rating is used to determine the parent/caregiver's capacity to provide the level of monitoring and discipline needed by the child/youth.

0 This rating is used to indicate a parent/caregiver with good monitoring and discipline skills.

1 This level indicates a parent/caregiver circumstance in which supervision is generally adequate but inconsistent. This may include a placement in which one member is capable of monitoring and discipline but others are not capable or not consistently available.

2 This level indicates a parent/caregiver circumstance in which supervision and discipline are very inconsistent and frequently absent.

3 This level indicates a parent/caregiver circumstance in which appropriate discipline and supervision are nearly always absent or inappropriate.


75. PROBLEM SOLVING This item describes the parents’ ability to resolve conflicts in the family and to find solutions to family functioning problems.

0 The parents/caregivers are able to collaboratively solve family functioning problems. 1 The parents/caregivers have some difficulties in resolving conflicts and may impose

solutions that may not be accepted by everyone in the family. 2 The parents/caregivers have significant difficulties in resolving conflicts and choose

solutions that maintain or enhance conflicts. 3 The parents/caregivers are unable to resolve conflicts and are triggering explosive

behaviours.

76. ORGANIZATION This rating should be based on the ability of the parent/caregiver to participate in or direct the organization of the household, services, and related activities.

0 Parent/Caregiver is well organized and efficient.

1 Parent/Caregiver has some difficulties with organizing or maintaining household to support needed services. For example, may be forgetful about appointments or occasionally fails to call back case manager.

2 Parent/Caregiver has significant difficulty organizing or maintaining household to support needed services.

3 Parent/Caregiver` is unable to organize household to support needed services.


77. KNOWLEDGE OF CHILD This rating should be based on parent/caregiver's knowledge of the specific strengths of the child/youth and any problems experienced by the child/youth and their ability to understand the rationale for the treatment or management of these problems.

0 This level indicates that the present parent/caregiver is fully knowledgeable about the child/youth's psychological strengths, weaknesses, talents, and limitations. Parent/caregiver has realistic expectations of the child/youth and supports his/her best efforts.

1 This level indicates that the present parent/caregiver, while being generally knowledgeable about the child/youth, has some mild deficits in knowledge or understanding of either the child/youth's psychological condition or his/her talents, skills, and assets. Child/youth may be supported in efforts; however, expectations may be higher than level child/youth can perform to.

2 This level indicates that the parent/caregiver does not know or understand the child/youth well and that notable deficits exist in the parent/caregiver's ability to relate to the child/youth's problems and strengths. Unrealistic expectations of child/youth. High level of parental pressure.

3 This level indicates that the present parent/caregiver has a significant problem in understanding the child/youth's current condition. The placement is unable to cope with the child/youth, given his/her status at the time, not because of the needs of the child/youth but because the parent/caregiver does not understand or accept the situation.

78. PARENTAL RESPONSIVENESS This item describes the parents/caregiver’s ability to understand the child/youth’s expression of emotion and respond in an emotionally effective manner (e.g., calming an anxious child/youth, soothing a child/youth in pain).

0 Caregiver is strong in his/her capacity to understand how the child/youth is feeling and

consistently demonstrates this in interactions with the child/youth. 1 Caregiver has the ability to understand how the child/youth is feeling in most situations

and is able to demonstrate support for the child/youth in this area most of the time. 2 Caregiver is only able to respond toward the child/youth in some situations and at times

the inability to respond interferes with the child/youth’s growth and development. 3 Caregiver shows no ability to respond to the child/youth in most situations especially

when the child/youth is distressed. Caregivers’ lack of appropriate response is impeding the child/youth’s development.


79. ABILITY TO LISTEN This item refers to the parent’s ability both to sit quietly and listen and to actually hear and understand what other people tell them about their parenting style and their child/youth’s needs and strengths.

0 Parent(s) is able to listen carefully and understand both good and bad news regarding

family and child/youth issues. 1 Parent(s) has listening skills but sometimes struggle(s) to hear either good or bad news

regarding family and child/youth issues. 2 Parent(s) requires help learning to listen effectively. 3 Parent(s) require substantial help learning to listen effectively.

80. ABILITY TO COMMUNICATE This item describes the parents’ ability to articulate in an understandable way their thoughts, feelings, beliefs, and concerns regarding parenting and their child/youth’s needs and strengths.

0 Parents are able to express feelings and thoughts effectively with regard to family and

child/youth issues. 1 Parents are able to express feelings and thoughts but sometimes struggle to express these

so that others can listen and/or understand. 2 Parents require help learning to express feelings and thoughts effectively with regard to

family and child/youth issues. 3 Parents require substantial help learning to express feelings and thoughts effectively with

regard to family and child/youth issues.

81. UNDERSTANDING IMPACT OF OWN BEHAVIOUR ON CHILD/YOUTH This item is intended to describe the degree to which parents/caregivers have self‐awareness regarding how their actions and behaviour affect their child/youth.

0 Parent/caregiver has a clear understanding of the impact of his/her behaviour on

child/youth and is able to adjust behaviour to limit negative impact. 1 Parent/caregiver has some understanding of impact of his/her behaviour but may struggle

at time to change behaviour to limit negative impact. 2 Parent/caregiver has limited understanding of the impact of his/her behaviour on

child/youth. 3 Parent/caregiver has no understanding or denies any impact of his/her behaviour on

child/youth.


82. INVOLVEMENT WITH CARE

This rating should be based on the level of involvement the parent/caregiver (s) has in planning and provision of mental health and related services.

0 This level indicates a parent/caregiver (s) who is actively involved in the planning and/or implementation of services and is able to be an effective advocate on behalf of the child/youth.

1 This level indicates a parent/caregiver (s) who is consistently involved in the planning and/or implementation of services for the child/youth.

2 This level indicates a parent/caregiver (s) who is only somewhat or inconsistently involved in the implementation and planning of the care of the child/youth.

3 This level indicates a parent/caregiver (s) who is uninvolved with the care of the child/youth. Parent/caregiver likely wants individual out of home or fails to visit individual in out of home placement or acute care setting.

83. KNOWLEDGE OF SERVICE OPTIONS This item refers to the choices the family might have for specific treatments, interventions or other services that might help the family address their needs or the needs of one of the family’s members.

0 Parents have strong understanding of service options. 1 Parents have understanding of service options but may still require some help in learning

about certain aspects of these services. 2 Parents require assistance in understanding service options. 3 Parents require substantial assistance in identifying and understanding service options.


FAMILY NEEDS AND STRENGTHS 84. FAMILY FUNCTIONING The definition of family should be from the perspective of the child/youth (i.e., those individuals whom the child/youth considers to be family). The family can include all biological relatives with whom the child/youth remains in some contact and individuals with relationship ties to these relatives. Family functioning should be rated independently of the problems experienced by the child/youth, and can include frequent arguments, problems with siblings, marital difficulties, separation and/or divorce, siblings with mental health/juvenile justice problems, parental substance abuse, criminality, domestic violence, etc.

0 The child/youth’s family appears to be functioning adequately. There is no evidence of

problems in the family. 1 There is a mild to moderate level of family problems, including marital difficulties or

problems with siblings. 2 There is a significant level of family problems including frequent arguments, separation

and/or divorce, or siblings with significant mental health or juvenile justice problems. 3 There is a profound level of family disruption including significant parental substance

abuse, criminality, or domestic violence.

85. FAMIY NURTURANCE This item rates the family’s ability to nurture, support and communicate with one another.

0 Significant nuclear family strengths. This level indicates a family with much love and

respect for one another. Family members are central in each other’s lives. The child/youth is fully included in family activities.

1 Moderate level of family strengths. This level indicates a loving family with generally good

communication and ability to enjoy each other’s company. There may be some problems between family members.

2 Mild level of family strengths. Family is able to communicate and participate in each

other’s lives; however, family members may not be able to provide significant emotional or concrete support for each other.

3 This level indicates a child/youth with no known nuclear family strengths. The family

members generally do not communicate well and rarely enjoy one another’s company. The child/youth is not included in normal family activities.


86. FAMILY STRESS This item reflects the degree of stress or burden experienced by the family as a result of the child/youth’s needs as

described elsewhere in the assessment.

0 Family is able to manage the stress of child/youth’s needs.

1 Family has some problems managing the stress of child/youth’s needs.

2 Family has notable problems managing the stress of child/youth’s needs. This stress interferes with the functioning of the family.

3 Family is unable to manage the stress associated with child/youth’s needs. This stress

creates severe problems of family functioning.

87. SOCIAL RESOURCES/NATURAL SUPPORTS This rating refers to the financial and social assets (extended family) and resources that the parent/caregiver (s) can bring to bear in addressing the multiple needs of the child/youth and family. If child/youth is living independently then the rating applies to the financial and social assets available to the youth.

0 Parent/caregiver (or independent youth) has sufficient resources/natural supports so that

there are few limitations on what can be provided for the child/youth.

1 Parent/caregiver (or independent youth) has the necessary resources/natural supports to help address the child/youth’s basic needs and are helpful in the care and treatment of the child/youth.

2 Parent/caregiver (or independent youth) has limited financial and other resources (e.g. grandmother living in same town who is sometimes available to watch child/youth).

3 Parent/caregiver (or independent youth) has severely limited resources/natural supports that are available to assist in the care and treatment of the child/youth.


88. SAFETY This rating refers to the safety of the assessed child/youth. It does not refer to the safety of other family or household members based on any danger presented by the assessed child/youth.

0 This level indicates that the present placement is as safe or safer for the child/youth (in his

or her present condition) as could be reasonably expected.

1 This level indicates that the present placement environment presents some mild risk of emotional abuse, neglect, exposure to undesirable environments or occasional presence of questionable role models but no immediate risk is present.

2 This level indicates that the present placement environment presents a moderate level of risk to the child/youth including such things as the risk of neglect or abuse, few appropriate role models or exposure to individuals who potentially pose a risk to the safety of the child/youth.

3 This level indicates that the present placement environment presents a significant risk to the well‐being of the child/youth. Neglect or abuse is occurring or is at imminent risk to occur. Individuals in the environment are or have the potential to, significantly harm the child/youth.

89. STABLE LIVING SITUATION This dimension rates the child/youth’s current and likely future housing circumstances. If child/youth lives outside of the family home then the rating applies to the child/youth’s current residence.

0 Parent/Caregiver and child/youth have stable housing for the foreseeable future.

1 Parent/Caregiver and child/youth are currently in stable housing but have either moved in the past three months or there are significant risks of housing disruption (i.e., loss of job, change in foster / group homes).

2 Parent/Caregiver and child/youth have moved multiple times in the past year or current housing is unstable.

3 Parent/Caregiver and child/youth are currently homeless or have experienced periods of homelessness in the past six months and current housing remains unstable.


90. FINANCIAL RESOURCES This rating refers to the financial assets that the parents can bring to bear in addressing the multiple needs of the child/youth and family.

0 Parents have sufficient financial resources so that there are few limitations on what can

be provided for the child/youth. 1 Parents have the necessary financial resources to help address the child/youth’s basic

needs and are helpful in the care and treatment of the child/youth. 2 Parents have limited financial resources but are able to access some resources to assist in

the care of the child/youth (e.g. grandmother living in the same town who is sometimes available to watch child/youth).

3 Parents have severely limited financial resources that are available to assist in the care

and treatment of the child/youth.

and adolescent needs and strengths...

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